Cardiovascular disease is very common in women. It is still under diagnosed and under treated. Many women are not having their risk factors for cardiovascular disease properly addressed. Many healthcare professionals are uncertain about the role of hormones in cardiovascular disease. This article gives an overview of the most important risk factors for cardiovascular disease and how to manage those risk factors appropriately, based on the available evidence.
HarveyRECoffmanKEMillerVM. Women-specific factors to consider in risk, diagnosis and treatment of cardiovascular disease. Womens Health (Lond)2015; 11: 239–257.
4.
AnandSSIslamSRosengrenAet al.Risk factors for myocardial infarction in women and men: insights from the INTERHEART study. Eur Heart J2008; 29: 932–940.
5.
MendelsohnMEKarasRH. Molecular and cellular basis of cardiovascular gender differences. Science2005; 308: 1583–1587.
6.
KearneyPMWheltonMReynoldsKet al.Global burden of hypertension: analysis of worldwide data. Lancet2005; 365: 217–223.
7.
Lloyd-SherlockPBeardJMinicuciNet al.Hypertension among older adults in low- and middle-income countries: prevalence, awareness and control. Int J Epidemiol2014; 43: 116–128.
8.
LewingtonSClarkeRQizilbashNet al.Age-specific relevance of usual blood pressure to vascular mortality: a metaanalysis of individual data for one million adults in 61 prospective studies. Lancet2002; 360: 1903–1913.
9.
StaessenJBulpittCJFagardRet al.The influence of menopause on blood pressure. J Hum Hypertens1989; 3: 427–433.
10.
VasanRSLarsonMGLeipEPet al.Impact of high-normal blood pressure on the risk of cardiovascular disease. N Engl J Med2001; 345: 1291–1297.
OssewaardeMEBotsMLVerbeekALet al.Age at menopause, cause-specific mortality and total life expectancy. Epidemiology2005; 16: 556–562.
13.
van der SchouwYTvan der GraafYSteyerbergEWet al.Age at menopause as a risk factor for cardiovascular mortality. Lancet1996; 347: 714–718.
14.
LokkegaardEJovanovicZHeitmannBLet al.The association between early menopause and risk of ischaemic heart disease: influence of hormone therapy. Maturitas2006; 53: 226–233.
15.
AtsmaFBartelinkMLGrobbeeDEet al.Postmenopausal status and early menopause as independent risk factors for cardiovascular disease: a meta-analysis. Menopause2006; 13: 265–279.
16.
RossouwJEAndersonGLPrenticeRLet al.Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women’s Health Initiative randomized controlled trial. JAMA2002; 288: 321–333.
Baber RJ, Panay N and Fenton A. The IMS Writing Group 2016 IMS Recommendations on women's midlife health and menopause hormone therapy, Climacteric 2016; 19(2): 109–150.
19.
Biglia N, Cagnacci A, Gambacciani M, et al. Vasomotor symptoms in menopause: a biomarker of cardiovascular disease risk and other chronic diseases? Climacteric 2017; 20(4): 306–312.
20.
FrancoOHMukaTColpaniVet al.Vasomotor symptoms in women and cardiovascular risk markers: systematic review and meta-analysis. Maturitas2015; 81: 353–361.
21.
Hypertension: management of hypertension in adults in primary care. NICE Clinical Guideline (August 2011), www.nice.org.uk/guidance/cg127.
22.
Mancia G, Fagard R, Narkiewicz K, et al. Task Force for the Management of Arterial Hypertension of the European Society of Hypertension and the European Society of Cardiology. Blood Press 2014; 23(1): 3–16.
23.
Lloyd-SherlockPBeardJMinicuciNet al.Hypertension among older adults in low- and middle-income countries: prevalence, awareness and control. Int J Epidemiol2014; 43: 116–128.
24.
ReinerZCatapanoALDeBGet al.ESC/EAS Guidelines for the management of dyslipidaemias: the Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS). Eur Heart J2011; 32: 1769–1818.
25.
Cardiovascular disease: risk assessment and reduction, including lipid modification. NICE 2016, www.nice.org.uk/guidance/cg181.
26.
MaclarenKStevensonJC. Primary prevention of cardiovascular disease with HRT. Women’s Health2012; 8: 63–74.
27.
CollinsPWebbCMde VilliersTJet al.2016) Cardiovascular risk assessment in women – an update. Climacteric2016; 19: 329–336.
28.
LokkegaardEJovanovicZHeitmannBLet al.The association between early menopause and risk of ischaemic heart disease: influence of hormone therapy. Maturitas2006; 53: 226–233.
HamodaH. British Menopause Society and Women’s Health Concern. The British Menopause Society and Women’s Health Concern recommendations on the management of women with premature ovarian insufficiency. Post Reprod Health2017; 23: 22–35.
31.
L’HermiteM. HRT optimization, using transdermal estradiol plus micronize progesterone, a safer HRT. Climacteric2013; 16(Suppl. 1): 44–53.
32.
SantenRJ. Use of cardiovascular age for assessing risks and benefits of menopausal hormone therapy. Menopause2017; 24: 589–595.
33.
HulleySGradyDBushTet al.Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women. Heart and Estrogen/progestin Replacement Study (HERS) Research Group. JAMA1998; 280: 605–613.
34.
RossouwJEPrenticeRLMansonJEet al.Postmenopausal hormone therapy and risk of cardiovascular disease by age and years since menopause. JAMA2007; 297: 1465–1477.
35.
VitaleCMercuroGCerquetaniEet al.Time since menopause influences the acute and chronic effect of estrogens on endothelial function. Arterioscler Thromb Vasc Biol2008; 28: 348–352.
36.
BoardmanHMHartleyLEisingaAet al.Hormone therapy for preventing cardiovascular disease in post-menopausal women. Cochrane Database Syst Rev2015; 3: CD002229.
37.
MikkolaTSTuomikoskiPLyytinenHet al.Estradiol-based postmenopausal hormone therapy and risk of cardiovascular and all-cause mortality. Menopause2015; 22: 976–983.
38.
SchierbeckLLRejnmarkLToftengCLet al.Effect of hormone replacement therapy on cardiovascular events in recently postmenopausal women: randomised trial. BMJ2012; 345: e6409.
39.
HodisHNMackWJHendersonVWet al.Vascular effects of early versus late postmenopausal treatment with estradiol. N Engl J Med2016; 374: 1221–1231.
40.
LoboRAPickarJHStevensonJCet al.Back to the future: hormone replacement therapy as part of a prevention strategy for women at the onset of menopause. Atherosclerosis2016; 254: 282–290.
41.
MikkolaTSet al.Increased cardiovascular mortality risk in women discontinuing postmenopausal hormone therapy. J Clin Endocrinol Metab2015; 100: 4588–4594.
42.
WingroveCSGarrEGodslandIFet al.17beta-oestradiol enhances release of matrix metalloproteinase-2 from human vascular smooth muscle cells. Biochim Biophys Acta1998; 1406: 169–174.
43.
StanczykFZHapgoodJPWinerSet al.Progestogens used in postmenopausal hormone therapy: differences in their pharmacological properties, intracellular actions, and clinical effects. Endocr Rev2013; 34: 171–208.
44.
HonisettSYPangBStojanovskaLet al.Progesterone does not influence vascular function in postmenopausal women. J Hypertens2003; 21: 1145–1149.
45.
BoschitschEMayerhoferSMagometschniggD. Hypertension in women: the role of progesterone and aldosterone. Climacteric2010; 13: 307–313.